1. health and fitness

Talking Points: Medicaid Expansion in Montana
Montana Food Bank Network, March 2015
While we were disappointed that the Governor’s Healthy Montana Plan (HB 249) did not make it out of
committee, we are encouraged to see another plan for expansion on the table. The Montana Health and
Economic Livelihood Partnership Act (The HELP Act, SB 405) is a promising compromise that will provide access
to health coverage for up to 70,000 Montanans and bring our federal tax dollars back into the state.
Background – Medicaid Expansion
Each year, Montana’s health care providers treat thousands of low-income people who can’t pay for their care
because they can’t afford health insurance. This uncompensated care costs providers, as well as the state and
local communities, millions of dollars. Montana can help address this problem by accepting available federal
dollars to expand Medicaid to people earning less than 138 percent of the federal poverty line. Doing so would
allow up to 70,000 Montanans to access affordable health care coverage, helping reduce unpaid costs for
providers and improving the health of people across the state.
Montana is missing out on millions of dollars every day, in addition to thousands of jobs, by not expanding the
state’s Medicaid program. On January 1, 2014, the federal government made funds available to states that
choose to expand their Medicaid programs. Because Montana’s legislature has so far refused to accept the
federal funds and extend Medicaid coverage to as many as 70,000 low-income individuals, Montana has been
losing as much as $1.96 million of federal funds every day.
Additionally, Montana is losing out $1.38 million in increased labor productivity from the 12,000 jobs that
expansion is projected to create. This increased labor income would also help generate $143,750 in state and
local tax revenue every day. Medicaid expansion is an important opportunity for our state, and every day it is
delayed Montana loses out on millions of dollars that could be used to create jobs, support our economy, and
provide health care coverage to 70,000 low-income Montanans.
Montana HELP Act Overview (from the Montana Human Rights Network)
SB 405 expands access to Medicaid and accepts available federal funds, injecting hundreds of millions of
taxpayer dollars into Montana’s economy over the biennium, and provides tens of thousands of Montanans
health insurance. This is a smart policy for Montana and has bipartisan support - Republicans and Democrats
from both the House and Senate have already signed on as co-sponsors.
Organizations working to pass Medicaid expansion in Montana support SB 405 as a reasonable compromise
option. We feel an urgency to pass a policy this year so tens of thousands of Montanans don’t go any longer
without access to health coverage.
SB 405 uses the “Third Party Administrator (TPA)” model, which is the same model used to administer Healthy
Montana Kids. The TPA model is also what Governor Bullock used in his Healthy Montana Act. This is a
reasonable public/private partnership that ensures efficiency, encourages innovation, allows for negotiated
provider rates, and offers families a private insurance card.
There are a number of provisions in SB 405 that are concerning. People who enroll in the HELP plan would be
charged a premium equal to 2% of their modified adjusted gross income. That’s a real stretch for Montana’s
low-income families. Additionally, enrollees can be charged up to another 3% of their modified adjusted gross
income in co-pays. This cost sharing can add up to 5% of their modified adjusted gross income – that is the
maximum allowed under federal law.
• The good news is that co-pays will not be applied to preventative health care, health screenings,
immunizations, or generic pharmaceuticals for chronic medical conditions.
• There are penalties for failure to pay premiums:
o For Montanans below 100% of the poverty line, there is no disenrollment for nonpayment,
however the unpaid premiums become a collectable debt by the state.
o
For Montanans between 100%-138% of the poverty line, failure to pay within 90 days of
notice will result in disenrollment. They can be reenrolled upon payment. Enrollees can
avoid disenrollment by meeting two of the following provisions:
 Discharge from military service within year,
 Enrollment in a Montana university, college, or tribal college,
 Participation in workforce assessment,
 Participation in healthy behavior plan.
There is also an asset based fee provision. However, it only applies to people who have assets in excess of $250,000
of equity in a primary residence, a primary vehicle, and $50,000 in additional cash or cash-equivalent assets.
MFBN Talking Points
MFBN is a statewide food bank providing services to more than 200 partner agencies throughout the state. In
2014, our agencies served more than one in eight Montanans. As we work to meet the immediate need for
food, we know that truly ending hunger requires more than food assistance. It requires solutions that address
the root causes of hunger, and Medicaid expansion does just that. Expanding Medicaid would allow many of
our food pantry clients and other low-income Montanans to eliminate one source of constant struggle and
concern – lack of access to health care.
Emergency food providers work every day to help improve the nutrition, health, and well-being of the families
and individuals we serve. Lack of access to health care and medical expenses are significant challenges for our
clients, contributing to their need for food assistance. In our most recent 2014 survey of food pantry clients,
nearly 40% of households had at least one uninsured member.
• These households were more likely to have to pay for medical expenses instead of food, to have to
delay seeking medical care due to cost, and to have unpaid medical bills.
Having no or inadequate insurance often leaves households unable to afford care unless it is an emergency.
Delaying medical care can have serious implications on both the short and long-term health of food pantry clients,
worsening health conditions and leading to increased costs for both the client and the health care system.
Hunger has significant implications on the health outcomes of low-income Montanans due to inadequate
nutrition and inconsistent food access. These impacts are further exacerbated by lack of access to basic health
care. Health-related consequences of hunger include:
• Increased rates of sickness leading to missed days of work and additional medical costs
• Increased risk of obesity and chronic diseases such as heart disease, diabetes, cancer, and stroke
• Increased rates of depression, anxiety, and other mental health challenges
By choosing to not expand coverage, our state has allowed hard-working Montanans to fall through the cracks.
These individuals are not eligible for our existing Medicaid program, which requires parents of dependent
children to have an income close to half of the federal poverty line and does not provide any coverage to
childless adults. Nor can they afford to purchase health insurance through the federal exchange, with many
actually making too little money to qualify for a subsidy.
Many Montanans in this coverage gap are the same individuals and families we are serving at our food
pantries. These are people who are struggling in jobs that don’t provide enough hours, offer benefits, or pay a
wage high enough to support a family.
SB 405 is a promising compromise to expand Medicaid coverage to the thousands of Montana families and
individuals in the coverage gap. We do have some concerns about the bill including the monthly premiums and
copays, which can total up to 5% of annual income. Overall, however, we are excited about this compromise
bill, which already has strong bipartisan support. It expands health care coverage to those who so desperately
need it and brings our federal tax dollars back to Montana. Medicaid expansion will create new jobs, help our
economy, support our rural hospitals, and improve the health and productivity of all Montanans, including
those struggling with hunger. Let’s pass SB 405, the Montana HELP Act.
For more information, contact Lorianne Burhop at the Montana Food Bank Network at 406-721-3825 x230 or lburhop@mfbn.org